title: Can mechanical balloon dissection be applied to cleave fibrotic submucosal tissues? A pilot study in a porcine model.
abstract: OBJECTIVE
  Removal of a lesion containing an ulcer scar is one of the most challenging applications of endoscopic submucosal dissection (ESD). The present study examined whether a novel balloon dissector could cleave fibrotic submucosal tissue beneath ulcer scars.
  
  
  METHODS
  Six pigs were studied. Endoscopic mucosal resection (EMR) with ligation was performed at 7 or 8 sites in the stomach for each animal; 4 weeks later, 23 sites with a visible scar were selected for submucosal dissection. The procedure involved first creating a submucosal fluid cushion (SFC) by injecting either saline mixed with mesna or pure saline. A slender, compliant balloon with a diameter of 8, 13, or 18 mm was inserted into the SFC. The balloon was unfolded and thrust forward to cleave the fibrotic submucosa over approximately 5 cm.
  
  
  RESULTS
  Fibrotic submucosa was dissected within 90 seconds in 17 of 23 attempts. Isolating the ulcer scar from the muscularis with the SFC prior to balloon dissection and using a thinner balloon catheter both ensured a better dissection.
  
  
  CONCLUSIONS
  The fibrotic submucosa underlying post-EMR scars can be dissected with the novel balloon dissector, although the technique is less effective in cases with no sign of lifting.
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Dobashi
authors.forename: K
authors.initials: K
authors.lastname: Sumiyama
authors.forename: C J
authors.initials: CJ
authors.lastname: Gostout
authors.forename: T R
authors.initials: TR
authors.lastname: Ohya
authors.forename: M
authors.initials: M
authors.lastname: Kobayashi
authors.forename: H
authors.initials: H
authors.lastname: Imazu
authors.forename: H
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000818:Animals; D002921:Cicatrix / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D004195:Disease Models, Animal; D004210:Dissection / Q000295:instrumentation* / Q000379:methods; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery*; D010865:Pilot Projects; D013276:Stomach Ulcer / Q000150:complications; D013552:Swine